Before Hunter S. Thompson killed himself at age 67, he had all the landmark warning signs of impending suicide for someone in his age group.

An American journalist and author, best known for his gritty, first-person style of Gonzo journalism that places the journalist as a central figure in his stories, Thompson was known for more than his unrestrained writing style. He used drugs heavily, was an alcoholic, and given his suicide note, undeniably depressed.

Four days before he killed himself, he wrote a note to his wife Anita, that went as follows: “No More Games. No More Bombs. No More Walking. No More Fun. No More Swimming. 67. That’s 17 years past 50. 17 more than I needed or wanted. Boring. I am always bitchy. No Fun – for anybody. 67. You are getting Greedy. Act your old age. Relax – This won’t hurt.”

Depression at Thompson’s age – over age 65 - is a known risk factor for suicide, in addition to substance abuse and physical illnesses. Thompson was also struggling with a broken leg and a hip replacement.

The Highest Suicide Rates

The suicide in 2005 of this iconic figure made the headlines because of his idiosyncratic journalism, but also because of his friendships and connections to actors and politicians. He was famous, so his suicide ranked as an important news story.

What doesn’t necessarily make the headlines, however, is that suicide among an entire population of older individuals happens at an alarmingly high rate – across the world.

Research studies and statistics from the World Health Organization confirm that suicide rates in people over the age of 65 and especially over the age of 75 are the highest rates of all age groups in most industrialized countries.

Writing in Gerontology, researchers Margda Waern, Eva Rubenowitz, and Katarina Wilhelmson, state that a number of factors specific to the elderly affect this high rate. Older individuals must confront a number of losses, including health, status, autonomy, work, family roles, and important relationships.

In a study they summarized in the article “Predictors of Suicide in the Old Elderly,” these researchers from Göteborg University, Göteborg, Sweden, broke down the age category into two groups. They called the first group the young elderly, a group representing those age 65 to 74 years.

The second group, those aged 75 and over, the group with the strikingly largest number of suicides, were the old elderly.

Depression is Main Suicide Predictor

Among both groups, depression was a significant predictor of suicide, but the Swedish researchers found that significant or major depression might increase more in the old elderly group, increasing this group’s suicide rate.

More social isolation, bereavement, a decrease in daily activities, declining physical health, and institutionalization all contribute to increasing depression as people enter the old elderly group. More depression in combination with the fact that the old elderly do not generally seek treatment for depression nor take antidepressant medications increases the probability of attempted suicides.

Family discord or conflict was also a leading predictor for both the young and old elderly age groups. And the more physical illnesses an individual over age 65 must contend with, the greater the possibility of suicide.

Simply stated, all the factors contributing to either minor or major depression after age 65 contribute to the high suicide rates – among both the young and old elderly- and it’s those factors that must be addressed before the rates can be impacted and reduced.

The Aging Population

The vast number of Americans over the age of 65 adds to this perfect storm for a major public health problem. According to estimates by the U.S. Census Bureau, in the year 2010, 34 million Americans are currently between the ages of 65 and 84. By the year 2030, the Bureau expects that number to reach about 64 million.

Because of the rising population growth among older individuals, researchers predict suicide to become the tenth most common form of death in the world for individuals over age 65 by the year 2020.

These rising numbers of elderly in combination with rising suicide rates lead the Swedish researchers to conclude that all those who interface with the elderly, from home health care aides to doctors and relatives must enhance their skills for recognizing both minor and major depression – and any underlying suicidal thoughts or ideas.

Prevention Works

Following the Swedish study, and uncovering an opposite trend of suicide among a specific group of the older population, Finnish researchers conducted a notable suicide research study. What they uncovered was a group of elderly citizens in Northern Finland with actually lower suicide rates than younger adults.

In the article “Rates and Previous Disease History in Old Age Suicide,” a group of seven researchers from a number of universities in Finland saw a 22.5% rate of suicide among the elderly compared to 38.4% for adults 18 to 64 years old. This occurred over a 15-year period in a northern province of Finland called Oulu.

Furthermore, the Finnish researchers writing in the International Journal of Geriatric Psychiatry saw a decreasing rate of suicide for both age groups over this time period. They attributed this decline to “rigorous” prevention measures, funded by a social health care system that covers all citizens. (The Finnish researchers were Hannu J. Koponen, Kaisa Viilo, Helinä Hakko, Markku Timonen, V. Benno Meyer-Rochow, Terttu Särkioja, and Pirkko Räsänen.)

These prevention programs gained momentum with primary care physicians and other health care workers who were trained to properly diagnose signs of depression and suicide ideation. Two-thirds of those in the study who considered suicide had contact with a primary care worker within one year prior to the attempt, signaling the crucial relationship between medical doctors and patients of this age.

Prevention meant also having a support system in place for those being treated for either minor or major depression, especially when connected with a physical illness. A support system among those who provide follow-up care became especially important since suppression of suicidal ideation may take up to 12 weeks before thoughts dissipate.

In addition, over the course of the 15-years studied, the Finnish health care system increased the use of antidepressant medications for the elderly.

Other factors considered important in the decline of suicide for this elderly Finnish population included “widespread religiousness of the local population as well as close and stable social relationships in this area.”

Increasingly, workers in the mental health field, especially counselors and therapists, are working to combat suicide – in all age groups – through prevention programs, and teaching those prevention programs to everyone who interacts with the elderly. Working and treating older individuals requires increased sensitivity to issues that they confront and face daily, issues that are often overlooked by younger adults but greatly affect mental health as everyone ages.

A master’s degree is required to work as a mental health counselor, and most states require individuals to take a state licensing exam.

Middle-aged Suicide

A study published in the 2010 Sept./Oct. issue of Public Health Reports sends out a message that middle-aged suicide could be another serious public health battle facing Americans.

Emory Sociology Professor Ellen Idler and Associate Professor of Sociology at Rutgers University Julie Philips started out trying to unravel the issues surrounding old-aged suicide when they discovered additional, unexpected data.

Middle-aged suicide, specifically affecting the generation called the “baby boomers” is on the rise.

In 2010, the first of the baby boomers, or those born in 1945, turned 65, transitioning the oldest of the boomers into “golden boomers.” But that still leaves a large portion of the 76 million baby boomers born between 1945 and 1964 in what experts define as “middle age.”

Idler and Philips showed that suicide of those in this age group has been increasing at more than 2% for men and 3% for women between the years 1999 and 2005. And they state that this rate continues to rise.

The authors did not define the exact reasons for this increase, but hypothesized that a number of factors could be affecting the rising middle-aged suicide rate. They listed economic uncertainty and an increase in chronic illnesses for this age group as two important influencers.

They also stated that this generation, the healthiest and wealthiest of any preceding this generation might be experiencing distress and angst over their mortality.

The researchers also stated that baby boomers experienced one of the highest adolescent rates of suicide. They hypothesized that perhaps knowing someone that committed suicide – even from years ago – might contribute to the increasing rate. Knowing someone who committed suicide causes one to reflect on his or her own life, and this could impact suicidal ideation, the researchers speculated.

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